Provider Demographics
NPI:1952122335
Name:HENRIE, AMALIRA MINA AOIFE
Entity type:Individual
Prefix:
First Name:AMALIRA
Middle Name:MINA AOIFE
Last Name:HENRIE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 BIDWELL DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2043
Mailing Address - Country:US
Mailing Address - Phone:510-585-8144
Mailing Address - Fax:
Practice Address - Street 1:4414 BIDWELL DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2043
Practice Address - Country:US
Practice Address - Phone:510-585-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician